Quips, queries, and querulous quibbles from the quirky mind of Don Kahle

The Problem of Pain Intolerance

America has a problem with pain killers, but focusing on pain relief is skipping a step. Opioid addiction is spiraling out of control, killing middle-aged women in trailer parks, rock legends in residential elevators, and all points in between.

In March the Centers for Disease Control and Prevention issued opioid prescription guidelines, hoping to stem the tide. The United States Congress appears poised to pass legislation that would assist efforts to curb opioid use and add new safety measures.

Efforts have focused on dissuading doctors from treating patients suffering from chronic pain with addictive opioids. Any resulting addiction can quickly become a more serious health hazard than the original malady. Decades of direct-to-consumer marketing and patient empowerment initiatives have cornered doctors into a lose-lose proposition.

If they give their patients the magic pills they believe will help them, they risk endangering that patient’s health and life. If they refuse their patients’ requests, they risk corporate discipline and possible reduction of federal funding, based on client satisfaction surveys.

Pain relief is a secondary problem. It overlooks the primary problem, which is pain itself. At the Olympic Trials, I saw a man wearing a U.S. Marines T-shirt with this message: “Pain is weakness leaving the body.” Author and theologian C.S. Lewis wrote an entire book about pain. He described pain as God’s “megaphone to rouse a deaf world.”

What does it say about us that the pain hasn’t roused us, but the side-effects from making pain stop has? It may be the oldest doctor joke ever told: “Doc, it hurts when I do this!” prompts the reply, “Then don’t do that.”

That’s not what we want to hear. We want to keep doing everything we’re doing, even if it causes us pain. Except we don’t want the pain that comes with it. Why strengthen your muscles with exercise when steroids can have similar effects? Why give your heart and your joints less stress by losing weight, when pills can do the job with less effort?

Why face whatever pain you’re feeling when drugs are available to blunt or blur that pain? When we choose those easier paths, pain loses the opportunity to tell us something about our bodies, our selves, our life. Some of our efforts to lessen the pain can prevent us from learning the lesson of pain.

I recently asked outgoing Eugene Mayor Kitty Piercy what she envisioned for herself next year and beyond. She confessed that her answer might sound hokey, but it was honest and fresh, since her birthday had been the day before. She cited Eugene as a great city for “aging in place” and she hopes to do just that, right here — enjoying what Eugene offers everyone. In that way, she’ll continue to be a leader.

I’ve learned from her and many others that facing death cannot be separated from embracing life.

We should acknowledge that chronic pain is a special problem, especially when there are no physical symptoms. If you twist your knee, a physician can stretch and poke it to better understand the source of the pain. Not so with chronic psychological pain, much less when the body and spirit are shouting together.

Self-reporting of symptoms is less reliable. There’s very little distance between feeling pain and feeling bad. Narcotics are notoriously good at muting both. Our techniques for treating people who feel pain too often make things worse for people who feel bad.

A pill might help a little, but saying “I’m sorry” or joining a bowling league or learning to swim could help a lot. Deeper remedies become also more distant when a pill promises to suffice. Once the pill’s limit is hit, the solution at hand — literally — is to take two.

And so it goes. The pain lessens, unless you count the mounting desperation. Asking for help could mean fewer pills, more pain, and still nothing is better.

All because we couldn’t stop to listen to the pain, to learn its lessons, to redirect our goals and effort toward better outcomes for ourselves and others. That’s the promise of pain.